The present invention relates to apparatus particularly suitable for resection of tissue in the trachea in such conditions as subglottic stenosis and tracheal stenosis. The primary object of the invention is to provide a novel approach to the resection of such tissue by means of a semicylindrical scalpel associated with an optical device to allow visualization of the area being operated upon.
It is well recognized that the cricoid cartiliage, the narrowest portion of the pediatric airway, is quite sensitive to trauma of any form, especially the mechanical irritation of endotracheal intubation with the resultant formation of a stenotic and restrictive lesion. Because of the frequency of the problem and the difficulty in its management, several treatment modalities have been devised.
The original work to deal with this lesion was aimed at expanding the diameter of the cricoid with interposition grafts. With the advent of adequate visualization provided by the Hopkins rodlens telescope, however, endoscopic resection of the lesion of subglottic stenosis became more practicable. With the aid of this visualization, laser surgery, electrosurgery, and cryosurgery have been employed to resect this tissue.
In conjunction with cryotherapy, biopsy forceps advanced through the operating bronchoscope have been used to bite out small pieces of tissue. This is a time-consuming and technically difficult procedure which meets with limited success due to the fact that the frozen tissue is difficult to resect with the biopsy forceps, and also, the randomly ragged edges left after the procedure may not allow optimal tissue healing. There additionally is the likelihood of recurrent fibrosis.
The present invention was conceived and developed to provide a novel, useful, and improved surgical instrument, particularly, suitable for resection of subglottic stenosis and other tracheal lesions in conjunction with endotracheal cryotherapy, that could overcome the aforementioned problems associated with the cryotherapy and biopsy forceps modality. The instrument is a more mechanically advantageous device which, rather than biting small pieces of tissue, cuts readily through the fixed frozen tissue of the lesion thus requiring less time, fewer applications, and which, upon completion of the procedure, presents a smooth surface potentially more amenable to tissue healing and prevention of subsequent fibrosis than has previously been possible.